Anaphylaxis in Beekeeping : 37


Unfortunately we do not have wholly accurate statistics on the numbers of people suffering anaphylaxis from any cause, let alone specifically to bee venom. Nor do we know accurately what proportion of people stung by bees are beekeepers rather than gardeners, farmers or the general public. It is, therefore, very difficult to state accurately the level of risk to beekeepers specifically. There are approximately 240,000 honey bee hives in the UK most of these being kept by approximately 44,000 amateur beekeepers. Around 200 beekeepers manage some 40,000 bee colonies on a professional basis and are members of the Bee Farmers’ Association (2013 data from www.sustainweb.org).


Guidelines


The British Society for Allergy and Clinical Immunology (BSACI) published their Guidance on Diagnosis and Management of Hymenoptera Venom Allergy in 2011. The following selective summary of some of the data and issues relating to venom allergy discussed in the document goes some way to identifying the risk: • Deaths due to insect stings are very rare in the general population. The best data available suggest approximately 25% of anaphylaxis deaths are caused by wasp and bee venom, where the average age of death is 50 years.


• There are approximately 20 deaths per year in the UK due to anaphylaxis (though this may be an underestimate owing to under-diagnosis and other factors).


• Risk of a systemic reaction, in the general population, including beekeepers, is thought to be increased significantly if a previous sting was within two months, even if the earlier sting was well tolerated.


• The estimated risk of a systemic reaction after a previous large local reaction is 5–15% and 40–60% after a previous systemic reaction.


• Beekeepers and their families have a sensitisation rate to bee venom of 30–60% – with a prevalence of local reactions of 9–31% and systemic reactions of 14–32%.


• Systemic reactions are more common in the early years of beekeeping.


April 2015 Vol 97 No 4


• Having 15–20 stings per year puts the beekeeper at higher risk of systemic reactions.


• Beekeepers who are stung more than 200 times per year appear to be protected.


• Bee venom is delivered in greater volume/concentration than wasp venom.


• There are approximately four deaths from bee and wasp venom per year. Most bee deaths are in beekeepers.


It is rare for individuals to be allergic to both bee and wasp venom as there is very low cross-reactivity. Cross-reactivity is high between honey bees and bumblebees; cross-reactivity is high between wasp and hornet venom.


Management


One of the most powerful control measures is ensuring you know what to do, when and how, if you or someone you are with starts suffering symptoms of anaphylaxis or, indeed, any other medical emergency. A well-thought-through and regularly rehearsed management plan should be the norm for all beekeepers. In practical terms some very particular issues arise when dealing with an emergency at the apiary. These need addressing and might include for example: • The emergency services may not be able to attend the casualty while in the immediate apiary environment, for their own safety.


• The apiary may be in a remote or difficult to access (for an ambulance) location, which could cause a critical time delay.


• The beekeeper may be working alone. Lone worker risk is higher and needs even more careful planning including informing others, timescales for return/or ‘phoning in’, emergency plan for backup and much more.


• A beekeeper may be unable to dial on a touch-screen mobile phone with gloves on.


• It may be very difficult to assess the condition of a collapsed beekeeper through a beesuit, possibly in poor light, rain, etc.


• Collapse may be for reasons other than anaphylaxis such as heart attack, stroke or heat exhaustion, for example.


• Do you have the up-to-date knowledge and skills necessary to treat an unconscious or non-breathing casualty?


• Would it be possible to give resuscitation through veils, which would increase the risk to both casualty and rescuer of being stung?


• Is the adrenaline pen immediately accessible? Do you know how to use it? Are you able to administer it yourself? Is it in date? (NB. There are many more issues to do with administration of adrenaline pens that need consideration.)


At the very minimum, if risk of anaphylaxis is perceived by beekeepers as being high, one of the most powerful control measures is ensuring that you have the competence and confidence to deal with emergencies, including unconsciousness and resuscitation. Clearly these skills have a place in normal everyday life. They will be the subject of a further article in next month’s Bee Craft and, together with Anaphylaxis Management, are included in training (see below) being organised by several beekeeping associations to ensure members have the knowledge and skills to cope in an emergency.


Next Month In my next article I will be looking at


treatment of anaphylactic shock including unconsciousness, resuscitation and delivery of automatic adrenaline injectors (AAIs) such as EpiPen® and Jext®. ♠


Andrea Woolley is a registered nurse with many years’ experience of working in hospital Accident & Emergency. She holds a degree in occupational health and safety and was assistant safety adviser for London University for many years. In 2005, she suffered anaphylactic shock from wasp venom.


Originally inspired by Bedfordshire Beekeepers’ Association, Andrea has facilitated a number of purpose-designed workshops on Anaphylaxis Management & CPR (cardiopulmonary resuscitation) for Beekeepers. So far, she has presented these for Bedfordshire and Surrey Beekeepers’ Associations. She is booked to present in Buckinghamshire and Cardigan.


Andrea brings a quiet authority to her training as a result of her depth of experience and these workshops have been very well received by over 100 attendees so far.


Any local association wishing to arrange a similar training course should contact Andrea on andrea.woolley@live.co.uk


www.bee-craft.com


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